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Behandling af hypertension

Behandling af hypertension. IRF 31-01-08 Tage Lysbo Svendsen Ledende overlæge dr.med Holbæk Sygehus Formand for Dansk Hypertensionsselskab. Category. Systolic. Diastolic. Optimal. <120. and. <80. Normal. 120-129. and/or. 80-84. High Normal. 130-139. and/or. 85-89.

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Behandling af hypertension

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  1. Behandling af hypertension IRF 31-01-08 Tage Lysbo Svendsen Ledende overlæge dr.med Holbæk Sygehus Formand for Dansk Hypertensionsselskab

  2. Category Systolic Diastolic Optimal <120 and <80 Normal 120-129 and/or 80-84 High Normal 130-139 and/or 85-89 Grade 1 Hypertension 140-159 and/or 90-99 Grade 2 Hypertension 160-179 and/or 100-109 Isolated Systolic Hypertension ≥140 and <90 Definitions and Classification of Blood Pressure Levels (mmHg) Grade 3 Hypertension ≥180 and/or ≥110

  3. Stratification of CV risk in four categories Blood pressure (mmHg) SBP: systolic blood pressure; DBP: diastolic blood pressure; CV: cardiovascular; HT: hypertension. Low, moderate, high, very high risa refer to 10year risk of a CV fatal or non-fatal event. The term “added” indicates that in all categories risk is greater than average. OD: subclinical organ damage; MS: metabolic syndrome.

  4. Non farmakologisk behandling • Motion • Saltrestriktion • Afmagring ved overvægt • Reduktion af alkoholindtagelse • DASH diet

  5. Farmakologisk behandling • Diuretika • Betablokkere • Calciumantagonist • ACE/AII-antagonister • Reninantagonister • Alfa-blokkere • Centralt virkende antihypertesiva • Aldosteronantagonister

  6. Betablokkere • Beta1selektive(atenolol,metoprolol) • Non- selektive(Propranolol) • Alfa-betablokkere(carvedilol, labetalol) • Uspecifik vasodilaterende (nebivolol)

  7. Reduction in the Risk of Stroke1 8 Fatal and nonfatal stroke 7 Atenolol 6 5 Losartan 4 Proportion of patients with first event(%) 3 2 Adjusted risk reduction 24.9%, p = 0.0010 Unadjusted risk reduction 25.8%, p = 0.0006 1 0 0 6 66 18 54 12 24 30 36 42 48 60 Time (months) Losartan (n) 4605 4528 4469 4408 4332 4273 4224 4166 4117 3974 1928 925 Atenolol (n) 4588 4490 4424 4372 4317 4245 4180 4119 4055 3894 1901 897 Number at risk No significant difference in CV death and MI vs. atenolol. Risk reduction = relative risk vs. atenolol. 7 1. Dahlöf B et al. Lancet 2002;359:995-1003.

  8. Ascot • Atenolol (+diuretica) versus Amlodipin (+ace) 19. 257 pt. • Signifikant reduktion i Apopleksi,Kardiovaskulærmortalitet,AMI på 11-24%

  9. Thiazider • Thiazider er lige så effektive til at sænke blodtrykket og til at reducere morbiditet og mortalitet som ACE-hæmmmere, A-II-antagonister, calciumantagonister og betablokkkere. • I de doser der anvendes i dag er bivirkningsfrekvensen lav.

  10. Calciumantagonister • Dihydropyridin derivater (amlodipin, nifedipin og mf) • Non – dihyropyridin (verapamil og diltiazem)

  11. ACE/AII-antagonister • ACE (Ramipril,enalpril,perindopril lisinopril og mf) • AII-antag.(Losartan,irbesartan, candersartan og mf) • Reninantagonister

  12. Andre antihypertensiva • Alfa- blokker (Prazosin,doxazosin terazosin) • Centralt virkende (methyldopa,moxonidin)

  13. Den ukomplicerede hypertensions patient • Calciumantagonist f.eks amlodipin • To stof behandling: 1)Ace- inhibitor f.eks enalpril, • Tre stof behandling:Tiazid (eller ACE eller Beta blokker)

  14. Possible combinations between some classes of antihypertensive drugs Thiazidediuretics Angiotensin receptor antagonists β-blockers Calcium antagonists α- blockers ACE inhibitors The preferred combinations in the general hypertensive population are represented as thick lines. The frames indicate classes of agents proven to be beneficial in controlled intervention trials

  15. Diabetes Mellitus AMI Hjerteinsufficiens Nyresygdom Angina Apopleksi Ace-inhib/a-II antag. Betablokker Ace- Inhib/ betablok Ace-inhib Betablok /calciumanta Ace-inh./A-II-anta

  16. Antal patienter i monoterapi

  17. Antal pt.i to-stof behandling

  18. Antal pt. i tre-stof behandling

  19. Pris fire-stof kombinationsbehandling • Thiazid Centyl c Kcl 1,44 kr • Betablok Atenolol mg100 0,71 kr • Calciumanta. Amlodipin 10mg 0,63 kr • Ace inhib. Enalpril mg 20 0,71 kr • Fire-stof kombin. 3,49 kr

  20. Pris fire-stof kombinationsbehandling • Thiazid Centyl c Kcl 1,44 kr • Beta Bisoprolol mg 10 3.15 kr • Calciumant Myonil mg 240 10,70 kr • Coversyl mg 8 6,40 kr • A-II antag irbesartan 300mg 11,41 kr • Fires-tof kombinationsbeh. 33,10 kr

  21. Mest anvendte behandling 2006 • Monoterapi Diureticum 104261 • To-stof beh. Ace/AII+Diur. 115516 • Tre.stofbeh Cal+ACE+D 49563

  22. Sundhedsstyrelsen

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